Kelley Assessment & Planning Services
WORKSHOP
REGISTRATION FORM
Please Type or Print
Name
_______________________________________________________________________
Dept/Program
________________________________________________________________
Institution
___________________________________________________________________
Address
_____________________________________________________________________
City/State/Zip
_______________________________________________________________
Work
Phone _____________________________ Home Phone ___________________________
Fax
_________________________________ E-mail __________________________________
List the workshop location: _______________________________________________________
List the workshop date:
__________________________________________
The registration fee is $100. Lunch is provided.
Please
mail a completed form and check payable to KAPS to:
Larry H. Kelley
824
Contact aukelley@aol.com
for additional information.